Cancer - An Ayurvedic Perspective

Pharmacological Research 51 (2005) 19–30

Cancer—an ayurvedic perspective

Premalatha Balachandrana,∗, Rajgopal Govindarajanba National Center for Natural Products Research, Department of Pharmacognosy, University of Mississippi, MS 38677, USAb Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198-4525, USA

Accepted 23 April 2004

Abstract

An integrated approach is needed to manage cancer using the growing body of knowledge gained through scientific developments.Thousands of herbal and traditional compounds are being screened worldwide to validate their use as anti-cancerous drugs. The science ofAyurveda is supposed to add a step on to the curative aspects of cancers that have resemblance with clinical entities ofarbudaandgranthimentioned inSushrutha samhita. Hence, an attempt is made in this review to discuss about the pathology and therapeutic management ofvarious cancers described in Ayurveda. Review of literature on anticancer drugs of plant origin revealed identification of newer ayurvedicdrugs that are not mentioned in the ancient texts. These new findings add up to ayurvedic science that has been developed through ages.In addition, details of experimental and clinical studies conducted on single and compound ayurvedic preparations for their anticancerefficacy strongly emphasize ayurvedic therapy as a scientifically driven one and not simply unconventional.© 2004 Elsevier Ltd. All rights reserved.

Keywords:Cancer; Ayurveda; Treatment; Medicine; Herbal

1. Introduction

Cancer is one of the most dreaded diseases of the 20thcentury and spreading further with continuance and increas-ing incidence in 21st century. In the United States, as theleading cause of death, it accounts for 25% of all the deathsin humans presently. It is considered as an adversary ofmodernization and advanced pattern of socio-cultural lifedominated by Western medicine. Multidisciplinary scientificinvestigations are making best efforts to combat this disease,but the sure-shot, perfect cure is yet to be brought into worldmedicine.

Recently, a greater emphasis has been given towards theresearches on complementary and alternative medicine thatdeals with cancer management. Several studies have beenconducted on herbs under a multitude of ethno botanicalgrounds. For example, Hartwell[1–9] has collected dataon about 3000 plants, those of which possess anticancerproperties and subsequently been used as potent anticancerdrugs[10]. Ayurveda, a traditional Indian medicine of plantdrugs has been successful from very early times in usingthese natural drugs and preventing or suppressing varioustumours using various lines of treatment.

∗ Corresponding author. Tel.:+1 662 915 1054; fax:+1 662 915 7062.E-mail address:[email protected] (P. Balachandran).

The broad aim of this article is to provide a general out-line on descriptions of cancers and their management froman ayurvedic practitioners’ perspective underlying its scien-tific principles involved in treating these conditions with theuse of natural products. This article reviews the availableliterature regarding researches on anti-cancerous ayurvedicherbs and also includes a summary of treatment strategiesfor various cancers. It is written with an intention to raiseawareness and encourage implementation of ayurvedic ther-apies for combating cancer and suggesting an integrated ap-proach in tumour management and treatment.

1.1. Ayurvedic concept of cancer

Charaka[11] andSushruta[12] samhitas, two well-knownAyurvedic classics, describe cancer as inflammatory ornon-inflammatory swelling and mention them as eitherGranthi (minor neoplasm) orArbuda (major neoplasm).Ayurvedic literature defines three body-control systems,viz., the nervous system (Vata or air), the venous system(Pitta or fire), and the arterial system (Kapha or water)which mutually coordinate to perform the normal functionof the body. In benign neoplasm (Vataja, Pittaja or Kaphaja) one or two of the three bodily systems are out of controland is not too harmful because the body is still trying tocoordinate among these systems. Malignant tumours (Tri-dosaja) are very harmful because all the three major bodily

1043-6618/$ – see front matter © 2004 Elsevier Ltd. All rights reserved.doi:10.1016/j.phrs.2004.04.010

20 P. Balachandran, R. Govindarajan / Pharmacological Research 51 (2005) 19–30

systems lose mutual coordination and thus cannot preventtissue damage, resulting in a deadly morbid condition[12].

1.2. Fundamental classification

Ayurvedic classification of neoplasm depends on variousclinical symptoms in relation toTridoshas.

Group I: Diseases that can be named as clear malignancy,which includesarbudaandgranthi, e.g.mamsar-buda (melanoma) andraktarbuda (leukaemia),mukharbuda(oral cancer), etc.

Group II: Diseases that can be considered as cancer, suchas incurable ulcers with e.g.tridosaj gulmas(ab-dominal tumours like carcinomas of the stomachand liver or lymphomas).

Group III: Diseases with the possibility of malignancy, e.g.Visarpa(erysipelas),asadhya kamala(incurablejaundice) andnadi vrana(sinusitis)[13,14].

1.3. Etiology

According toSushruta, the fundamental cause of majorneoplasm is the pathogens that affect all parts of the body.He called the sixth layer of the skin as‘Rohini,’ (epithelium)and pathogenic injuries to this layer in muscular tissues andblood vessels caused by lifestyle errors, unhealthy foods,poor hygiene and bad habits results in the derangement ofdoshas, which leads to the manifestation of tumours[12,15].Excess of water or fat in the corpus of the tumour and thestability and rigid confinement of thedoshasin a particularplace were described as reasons for the non-infectious andnon-suppurative nature of these abnormal growths[12,16].Cancer in each person differs according to the person’s ex-posure topathogensand genetic constitutions which makeeach of them to react differently to the same diet.

The factors responsible for the vitiation ofdoshasarediscussed here[17].

a. Vata aggravating factors: excessive intake of bitter, pun-gent, astringent, dry foods and stressful conditions.

b. Pitta aggravating factors: excessive intake of sour, salty,fried foods and excessive anger.

c. Kapha aggravating factors: excessive intake of sweet,oily food and sedentary nature.

d. Rakta aggravating factors: excessive intake of acid oralkali containing foods. Fried and roasted foods, alco-holic beverages, sour fruits are some examples. Excessiveanger or severe emotional upset, sunbathing or workingunder scorching sun or near fire and hot conditions, etc.are some other causes[11].

e. Mamsa aggravating factors: excessive use of exudativefoods like meat, fish, yoghurt, milk and cream. Be-haviours leading to exudation like sleeping during theday and overeating are some of the causes for pathogensinvading the fatty tissues[11].

f. Medo aggravating factors: excessive intake of oily foods,sweets, alcohol and lazy attitude[11,12].

1.4. Pathogenesis of tumours

According to Ayurvedic principles, the disease cannot benamed on its own because it differs between persons in termsof illness, clinical presentation and also the treatment re-quired[14]. Thus, pathogenesis in Ayurveda is explained onthe basis ofTridoshas. Agnior Pitta, which is present in eachand every cell, is responsible for digestion and metabolism inhuman body. The decrease inagni is inversely proportionalto the related tissue and therefore inarbuda,the decreasedstate ofdhatwagni(deranged metabolism) will result in ex-cessive tissue growth.

Vatacan be correlated with the anabolic phase of growthwhereaskaphato the catabolic phase. Cancer originates dueto a metabolic crisis, i.e. aggravation ofvataforces and sup-pression ofkaphaforces, both interacting with one anotherresulting in proliferation. However, the abnormal cancerousgrowth at a specific organ (Ekadesavriddhi) is managed bycompensation from other parts of the body (Anyasthaniyak-shaya), e.g. body weight loss (cachexia)[17]. Sushrutahasproposed six stages in the pathogenesis of all diseases buthis concept suits more to the pathology of the tumour thanpathogenesis itself.

1. Sanchaya: early stages of localized neoplastic changes.2. Prakopa: transformation of primary growths into

metastatic tumours.3. Prasara: metastasis.4. Sthana samsraya: complete metastasis and secondary

growth.5. Vyakti: clinical signs and symptoms are expressed.6. Bheda: the stage where differentiation of growth occurs

on the basis of histopathology[17].

2. Cancer therapy—a practical dilemma

Any practical solution in combating this dreadful diseaseis of paramount importance. An alternative solution to west-ern medicine embodied with severe side effects is the useof medicinal plant preparations to arrest the insidious natureof the disease. Many herbs have been evaluated in clinicalstudies and are currently being investigated phytochemicallyto understand their tumouricidal actions against various can-cers. Thus, cancer patients who already got crippled withthis disease, further burdened by drug-induced toxic side ef-fects have now turned to seek help from the complementaryand alternative medicine hoping for a better cure. Ayurvedictherapy was found to be able to cure these chronic dis-eases better, which were previously not amenable to treat-ment by western medical practices. This traditional Indianmedicine with its evolution through centuries has alwaysfascinated practitioners and researchers for its applications

P. Balachandran, R. Govindarajan / Pharmacological Research 51 (2005) 19–30 21

in cancer treatment on a scientifically proven research back-ground.

2.1. Principles of ayurvedic treatment

Abuse of nature’s law upsets the human system and endsup in disease like cancer. It is again the nature, the foremostphysician who brings the cure. The Ayurvedic system ofmedicine was well founded on the basic principles of natureand its elements after a careful and thorough study of humanphysiology. This is the first system to emphasize health as theperfect state of physical, psychological, social and spiritualcomponent of a human being.

The therapeutic approach of Ayurveda has been di-vided into four categories asPrakritisthapani chikitsa(health maintenance),Roganashani chikitsa(disease cure),Rasayana chikitsa(restoration of normal function) andNaishthiki chikitsa(spiritual approach)[18].

Finding the cause of an illness is the basic goal ofayurvedic therapy. It classifies disease development into sixstages that include aggravation, accumulation, overflow, re-location, build-up in a new location, and manifestation intoa recognizable disease. Ayurvedic physicians can diagnosean illness at even initial stages of body imbalance and theirtherapeutic approach maintains a balance by supplying de-ficient substances as well as reducing the excessive ones.Surgery is considered only for advanced cases.

2.2. Ayurvedic texts about cancer treatment

During the 7th century BC, Atreya and Dhanwantari usedherbal medicines for treating the early stages of cancer andsurgery in advanced cases. In the 8th century AD, Vagb-hata, a Buddhist physician composed two texts:Astanga Hr-daya [19] andAstanga sangraha[20] where new methodsfor cancer treatment were introduced. Other Ayurvedic textsof internal medicine, viz., Chakradatta[21] composed byChakrapani (10th century AD), theSarangadhara Samhita[22] by Sarangadhara (14th century AD), theBhavaprakashaSamhita[23] by Bhavamisra (15th century AD), the Sat-mya Darpan Samhita by Viswanath (16th century AD), theVaisajya Ratnabali by Binoda Lala Sen Gupta (18th CenturyAD), the Rasatarangini by Sadananda Sharma (19th centuryAD), etc. explain numerous remedies to treat internal andexternal neoplasms.

2.3. Treatment modalities

Sodhana chikitsa(purification process), which elimi-nates vitiateddoshas, have been primarily used for medicalmanagement of cancer. When both internal and externalmedications were given then it is called aspanchakarmachikitsa. The other type of curative therapy is calledsomanachikitsa, which pacifiesdoshaand gradually relieves the dis-ease. However, this treatment is prescribed only to weakerpatients for whomsodana chikitsais contraindicated. In

Rasayana prayoga(immunotherapy), certain poisonousplants, mercury like metals and animal products were ren-dered non-toxic and harmless by the use of alchemy and areused as rejuvenating drugs. Other methods of treatment in-clude,dhatwagni chikitsa(correction of metabolic defects),vyadhipratyanika chikitsa(specific anti-cancerous drugs)and lakshanika chikitsa(symptomatic treatment)[24].

When medical treatment practices fail, then the case wasleft to surgeons. Surgical cancer management inAyurvedainclude the principles of fomentation by means of externalapplication, cleansing by internal medication, treatment toliquefy the contents of the swelling, opening the tumour sur-gically for evacuation of its contents, cauterisation to avoidrecurrence and post-operative care for healing the wound[15].

Cauterisation with alkalis and acids and other surgical pro-cedures were performed with herbal and mineral medicines.Arbuda is excised completely from its deep root seat andcauterisation done to destroy any of the remaining cell par-ticles [24].

2.4. Classical drugs claimed in ayurvedic texts

Traditional line of treatment:Traditional methods em-ployed in treatment of various cancers were given inTable 1.In addition to these traditional methods, various herbal com-binations mentioned in Ayurvedic texts are listed inTable 2.The main objective of these tables is to support the physi-cians and researchers to utilize these traditional methods aswell as herbal drugs for an effective cancer treatment.

2.5. Scientific principles of Ayurvedic anticancer drugs

Herbal decoctions consisting of multiple herbs each pos-sessing tremendous potential for a cancer cure are commonlyused in Ayurveda. These formulations are reported to workon multiple biochemical pathways and are capable of influ-encing several organ systems simultaneously. The benefit ofan herbal decoction is that it can nourish the body as a wholeby supporting various organ systems[25]. Many of the herbsmentioned below have scientifically-proven anti-cancerousproperties and are used for the treatment of various cancers.

2.6. Andrographis paniculata

The extract and isolated diterpenes (andrographiside andneoandrographolide) from this plant are proved to be ben-eficial against tumourigenesis by their anti-lipoperoxidativeaction and by enhanced carcinogen detoxification action[26–29].

2.7. Annona atemoya/muricata

Bullatacin, an acetogenin isolated from the fruit ofAn-nona atemoya, induces apoptosis, preceded by chromatinmargination and tumour cells condensation[30]. Several


Table 1Classical treatment protocols for various tumours in Ayurveda

Type of tumour Tumour subtypes Classical treatment procedures

Granthi Vatika granthi Helloborus niger, Tinospora cordifolia, Clerodendron serratum, Aegle marmelos, Hoyaviridiflora, Elephantopus scaber, Soymida febrifugaand Gynandropis pentaphyllawereapplied locally[16]

Paittika granthi Terminalia chebulapowderwith either grape or sugarcane juice were used orally. Thepaste ofGlycyrrhiza glabra, Eugenia jambolana, Terminalia arjunaor Calamus rotangwere used of external application[16]

Kapaja granthi Paste ofCapparis spinosa, Capparis sepiaria, Agati grandiflora, Lagenaria vulgaris,Premna herbacea, Pongamia glabra, Musa sapientumand Randia dumetorumused inlocal application[16]

Arbuda Classical procedures Fomentations, cauterisation, scraping, blood letting, medicated enemata and other surgicalprocedures[17]

Traditional treatment Habitual intake ofBasella rubraor application of alkali preparation ofMusa paradisiaca,Conch shell ash, Elaeocarpus tuberculatus, Sulphur, Potassium carbonate, Embelia ribesand ginger were used to curearbuda [16]

Vataja arbuda Paste ofBenincasa cerifera, Cucumis memordica, Cocos nucifera, andEranda beeja,Ricinus communisalong with butter or milk were applied[65]

Pittaja arbuda Tumours were treated with leaves ofFicus glomerata, Tectona grandis,and Elephantopusscaberrepeatedly and then with a honey mixed fine paste ofAglaja roxburghiana,Caesalpinia sappa, Symplocos racemosa, Terminalia arjuna, Xanthium strumariumwasapplied[16]

Kaphaja arbuda After surgical removal of tumour, a drug that remove doshas from both the ends (vomitingand purgation) were employed. Then for purification, a decoction ofClitoria ternatea,Jasminum grandiflorumand Nerium odorumleaves was used. For the postoperative care,oil cooked withPremna herbacea, Embelia ribes, Cissampelos pareirawas applied

Medoja arbuda Curcuma domestica, Triticum sativum, Symplocos racemosa, etc. were made into a powderand applied externally by mixing them with honey. Oil fromPongamia glabrawere usedof internal administration[65]

Table 2List of herbs commonly used in ayurvedic anticancer treatment

No. Name of the herb Method and use

1 Vitis vinifera The mixture ofTerminalia chebula, grape juice andsugar cane juicehas been used (3).Resveratrol, a natural product derivative from grape juice has been proved to possess cancerchemopreventive activity[66]

2 Baliospermum montanum The paste comprising ofBaliospermum montanum, Plumbago zeylanica, Euphorbia neriifolia,Calotropis procera, jaggery,Semecarpus anacardiumapplied over the tumours[12]

3 Madhuca indica This paste is prepared from the barks ofMadhuca indica, Syzygium cumini, arjuna Terminaliaarjuna and Salix capreaand prescribed for local application[12]

4 Pandanus odoratissimum A paste ofPandanus odoratissimumwith sugar was applied externally[12]5 Pterospermum acerifolium The flowers ofPterospermum acerifoliummixed with sugar to be applied locally6 Raphanus sativus Local application ofRaphanus sativuspowder paste with the radish ash was considered

effective againstkaphaja arbuda7 Barleria prionitis The Barleria prionitis oil prepared with whole plant is indicated for external application

during acute stages of cyst in blood vessels[20]8 Prosopis cineraria This paste made up ofProsopis cinerariaseeds,Raphanus sativa, Moringa oleifera, barley

and mustard with sour buttermilk was applied locally for disintegrating cysts[20]9 Amorphopallus campanulatus The mature tuber is first burnt and then mixed with butter and jaggery and applied for tumour

destruction[12]10 Oxoxylum indicum The drugOxoxylum indicumprescribed in treatment ofgranthi [12]11 Basella rubra The plant and leaves are ground with sour buttermilk with salt for preparing a poultice and

indicated forarbuda [12]12 Flacourtia romantchi The paste ofFlacourtia romantchi, Cassia fistula, Capparis sepiaria, is recommended for

kaphaja tumours[12]13 Moringa oleifera The paste ofMoringa oleiferaseeds,Solanum xanthocarpum, Sinapis dichotoma, Holarrhena

antidysentericaand Nerium odorumroots prepared with buttermilk is used forarbudatumours[23]

14 Ficus bengalensis Application of mixture ofFicus bengalensisand Saussurea lappapacify tumour growth onbone[23]

15 Curcuma domestica The Curcuma domesticapowder in combination withSymplocos racemosa, Soymidafebrifuga, is mixed with honey and this is used as an external remedy[23]


other annonaceous acetogenins, e.g. muricins A–G, muri-catetrocin A and B, longifolicin, corossolin, and corossoloneare also showed to be significantly selective in bringing invitro cytotoxicities to tumour cells[31].

2.8. Phyllanthus niruri/amarus

An aqueous extract ofP. amarusincreases the life span ofthe tumour bearing rats and normalizes�-glutamyl transpep-tidase activity[32]. It plays a major role in disruption ofHBsAg mRNA transcription and post-transcription whichcould be beneficial against viral carcinogenesis[33].

2.9. Piper longum

Piperine, an active alkaloid extracted from this plant hasbeen used as an ingredient of ayurvedic anticancer formu-lations because of its anti-oxidative potency in both in vitroand in vivo conditions[34].

2.10. Podophyllum hexandrum linn. (Podophyllin)

It is a powerful anticancer drug against various cancers fore.g. sarcomas, adenocarcinoma and melanoma. Podophyllinand its active principle, podophyllotoxin are known for theircytotoxic effect by virtue of their properties of mitotic in-hibition, nuclear fragmentation, impaired spindle formationand they are also found to be karyoplastic. The mechanismof action has been suggested as necrosis and is a direct con-sequence of its cytotoxic effect on tumour tissues. Thesederivatives have been analysed in cancer chemotherapeuticstudies and the methods of preparation of these compoundsare patented[10].

In recent days, chemically modified podophyllotoxins arewidely used in cancer therapeutics. VP-16 (etoposide), apodophyllotoxin derivative has been tested against in vitroand in vivo cancer cells and been used against hepatic can-cers for more than a decade[35]. It has proved its efficacyin combination with epirubicin in phase II studies[36,37].By this combination therapy at least 3% of the patients hadcomplete cure and 36% had partial response. P-glycoprotein,a drug efflux pump, seems to be less effective in reducingVP-16 concentration in cancer cell lines and hence this drugproves to be more efficient in these cells[38]. It is also safeeven above therapeutic dosage without much toxic effects[39].

2.11. Tinospora cordifolia

The active principles fromT. cordifolia enhance hostimmune system by increasing immunoglobulin and bloodleukocyte levels and by the stimulation of stem cell prolif-eration. It has the ability to reduce solid tumour volume by58.8%, which is comparable to cyclophosphamide, a knownchemotherapeutic agent[40–42]. These immunostimulatingproperties can be used in the prevention of tumour mediated

immunosuppression and hence could be a drug choice forvarious cancers.

2.12. Semecarpus anacardium

In Ayurveda classics, numerous references are availableon the anticancer properties ofSemecarpus anacardiumnuts[43]. An extensive review describes the phytochemicaland pharmacological properties ofS. anacardium[44]. Thechloroform extract ofS. anacardiumnut possess antitumouraction with increased life span against leukaemia, melanomaand glioma[45,46]. The milk extract ofS. anacardiumproduces regression of hepatocarcinoma by stimulatinghost immune system[47] and normalizing tumour markersincluding alpha-fetoprotein levels[48,49]. This prepara-tion stabilizes the lysozomes, and normalizes glycoproteinand mineral content in the body during cancer progression[50,51]. It also corrects hypoglycaemia[52] and controlsabnormal lipid peroxidation[53] by the maintenance of an-tioxidant defense status[54]. In the microsomes, it acts asa bifunctional inducer of both phase I and II biotransforma-tion enzymes and prevents tumour initiation by preventingcarcinogen activation[55,56]. Histologically, on treatmentwith theS. anacardiumextract to hepatocarcinoma animals,the liver sections showed almost a normal architecture. Thenodules become completely regressed and further cell necro-sis was prevented[57]. Anacartin forte,another preparationfrom S. anacardiumhas been used for several decades as ananticancer drug since it is giving health improvement withalleviation or disappearance of troublesome symptoms. Itprovides clinical benefit with an extension of survival timein various cancers including oesophageal, chronic myeloidleukaemia, urinary bladder and liver cancer[58]. AnotherAyurvedic drug containingS. anacardium, Amura rohitaka,Glycyrrhiza glabra and copper powder were reported toinhibit breast tumour development in mice by significantlyextending the survival period. This drug was also found tobe efficient in clinical trials[13].

Ayurvedic herbs, which are widely used and scientifi-cally proven of their anticancer properties, are presentedin Table 3. Smit et al. [59] have also elaborately listedayurvedic herbal drugs with anticancer activity. Some ofthese herbs are shown to enhance the therapeutic efficacyand/or reduce the toxicity of anticancer drugs used inchemotherapy. Also few of them possess radiosensitising ef-fect too (seeTable 4). Pharmacological details of ayurvedicherbs like therapeutic dosage, side effects, and commentsabout safety and herb-drug interactions were given inTable 5.

3. Potential benefits of Ayurveda duringCancer cachexia

Cancer cachexia is a common clinical problem that sub-stantially impacts upon the quality of life and survival of


Table 3Scientific evidence on herbs used in Ayurveda proven to have anticancer property

Name of the herb Indications References

Abrus precatorius Yoshida sarcoma (rats) Subbareddy and Sirsi[67]Fibrosarcoma (mice)Ascites tumour cells

Albizzia lebbeck Sarcoma 180 (mice) Dhar et al.[68]Allium sativum Sarcoma (rat) Hu et al.[69]Aloe vera Yoshida AH-130 ascite hepatoma (pleural tumour)

human neuroectodermal tumoursCorsi et al.[70], Pecere et al.[71]

Alstonia scholaries HSI human sarcoma benzo(a)pyrene inducedforestomach carcinoma

Dhar et al.[68], Jagetia et al.[72]

Amura rohitaka Leukaemia Prasad and Deshpande[73], Rabi and Gupta[74]Anacardium occidentale Hepatoma 129 Dhar et al.[68]Asparagus racemosa Human epidermoid carcinoma Dhar et al.[68]Bacopa monniera Walker carcinosarcoma 256 Bhakuni et al.[75]Berberis aristata Human epidermal carcinoma of the nasopharynx

N-nitrosodiethylamine induced carcinogenesisBhakuni et al.[75], Anis et al. [76]

Boswellia serrata Human epidermal carcinoma of the nasopharynx Dhar et al.[68]Leukaemia and brain tumours Hostanska et al.[77]

Calotropis gigantea Human epidermal carcinoma of the nasopharynx Bhakuni et al.[75], Dhar et al.[68]

Curcuma longa Fibrosarcoma Sriganth and Premalatha[78]Preclinical and clinical trials review Aggarwal et al.[79]

Datura metel Human epidermal carcinoma of the nasopharynx Dhar et al.[68]Erythrina suberosa SARCOMA 180 Dhar et al.[68]Euphorbia hirta Freund virus leukaemia Dhar et al.[68]Gynandropis pentaphylla Hepatoma 129 Dhar et al.[68]Heliotropium indicum P-388 lymphocytic leukaemia Pal et al.[80]

Hygrophila spinosa Dalton’s lymphoma Maiti[81]Ehrlich ascites carcinoma and Sarcoma-180 Mazumdar et al.[82]

Ixora undulata P-388 lymphocytic leukaemia Dhawan et al.[83]Juniperus indica Human epidermoid carcinoma of the nasopharynx Dhawan et al.[83]Luffa cylindrica Schwartz leukaemia Bhakuni et al.[84]Melia azedarach Walker carcinosarcoma 256 Bhakuni et al.[75]

Moringa oleifera Human epidermoid lymphocytic leukaemia Dhawan et al.[83]Skin papillomagenesis Bharali et al.[85]

Nerium indicum Erlish ascites carcinoma Pal et al.[80]

Nigella sativa Lewis lung carcinoma Dhar et al.[68]Colon cancer Salim and Fukushima[86]

Ocimum sanctum Skin and liver tumours Dubey et al.[87]Paederia foetida Human epidermoid carcinoma of the nasopharynx Dhar et al.[68]Picrorrhiza kurroa Hepatic cancers Dhar et al.[68]Plumbago zeylanica Hepatoma Parimala and Sachdanandam[88]Rubia cordifolia P-388, L-1210, B-16 melanoma, colon 388, Lewis

lung carcinoma, mammary carcinomaItokawa et al.[89]

Taxus buccata Cytotoxic against various tumours Melado et al.[90]Vinca rosea P-1534, carcinoma of the breast, cervix, kidney, lung

and ovaryRastogi and Mehrotra[91]

Withania somnifera Various tumours Dhar et al.[68]

cancer patients. The pathophysiology of this syndrome im-plicates tumour induced metabolic changes and immune re-sponses. Clinical manifestations include anorexia, chronicnausea and change in body image. Among several potentialbenefits of ayurvedic medicine, relief from cancer cachexiais especially valuable. Ayurvedic herbs used in cancer ther-apy results not only in total healing, but also reduces the

side effects and cancer associated complications. It alsoavoids the need for supplemental therapy to manage can-cer cachexia. Each herbal product contains multiple activeprinciples that may operate synergistically, producing ther-apeutic benefits and lowering the risks on adverse effects.

The anorexia or weight loss could be effectively man-aged byWithania somnifera, Sida cordifolia, Asparagus


Table 4Therapeutic enhancement potential of ayurvedic herbs on cancer chemotherapy/radiation

Name of the herb Chemotherapy/ayurvedic herb intervention studies

Allium sativum Water-soluble derivative of garlic, S-allylmercaptocysteine (SAMC), inhibited proliferation and cell cycleprogression in two human colon cancer cell lines, SW-480 and HT-29, similar to the effects of sulindacsulfide (SS), a well-known colon cancer chemopreventive agent. Co-administration of SS with SAMCenhanced the growth inhibitory and apoptotic effects of SS, suggesting the usefulness of SAMC alone or incombination with SS or other chemopreventive agents[92]

Aloe vera In a randomised double-blinded clinical trial, comparing mild soap and aloe vera gel against incidence ofradiation therapy induced skin reactions, the median time of five weeks was taken to show any skin changesin the aloe/soap treatment versus three weeks in the soap only treatment. The protective effect of addingaloe to the soap regimen increases during long time radiation exposure[93]. In another clinical trialinvolving patients with advanced solid tumours, for whom no other standard effective therapy was available,combination of pineal indole melatonin (MLT) plus Aloe vera extracts produced some therapeutic benefits,at least in terms of stabilization of disease and survival when compared to MLT alone treatment[94]

Alstonia scholaris The Alstonia scholarisextract pre-treatment increased the effect of radiation as by enhancement of cellkilling in HeLa and KB cells, followed by HL60, MCF7, and HePG2 cells. In in vivo studies, with Ehrlichascites carcinoma bearing mice the pre-treatment of extract caused increased life span of animals whencompared with untreated irradiated group[95]. The combination treatment ofAlstonia scholarisextract withcyclophosphamide was also found to be most effective against Ehrlich ascites carcinoma as it caused thehighest tumour regression and enhanced the mean and average survival time when compared withcyclophosphamide alone treated group[96]

Curcuma longa When radiation and curcuma were applied together as synergical therapy, curcuma showed a radiationsensitising effect in HeLa, K-562 and IM-9 cell lines[97]. Curcumin, the active constituent fromCurcumalonga also enhances the anticancer potential of Cisplatin and reduces its nephrotoxicity in fibrosarcomabearing rats[78]

Heliotropium indicum In a Phase I study consisting of Solid tumour patients who have undergone prior chemotherapy/ radiationtherapy, Indicine N-oxide, an alkaloid fromHeliotropium indicumhave shown some improvement againstskin melanoma and ovarian carcinoma[98]

Moringa oleifera Pre-treatment with the leaf extract ofM. oleifera exhibits significant radiation protection to the bone marrowchromosomes in mice and this could be useful to overcome side effects of radiation therapy[99]

Nigella sativa In mice bearing Ehrlich ascites carcinoma, thymoquinone (TQ), the main constituent of theNigella sativaoil, significantly enhanced the therapeutic efficacy of ifosfamide by improving its antitumour effect andreducing its nephrotoxicity. Furthermore, mice treated with ifosfamide in combination with TQ showed lessbody weight loss and mortality rate compared to IFO single therapy[100]

Ocimum sanctum Orientin and Vicenin, two water-soluble flavonoids isolated from the leaves ofOcimum sanctumhave shownsignificant protection to the human lymphocytes against the clastogenic effect of radiation, radiation lethalityand chromosomal aberrations in vivo. This radioprotection associated with their antioxidant activity mayhave clinical potential in cancer therapy[101]

Taxus buccata In a Phase II study, the triplet regimen based on taxol (active constituent ofTaxus buccata), ifosfamide, andcarboplatin has proved active, safe, and easy to deliver on an outpatient basis for patients with advancedstage IIIB-IV non-small-cell lung cancer[102]. Another combination of Herceptin with Taxol significantlyimproves the overall response rate, increases the time to progression and the overall survival in breast cancerpatients. These effects are more pronounced in patients characterized with HER/2+++ over expression[103]. Taxol also exerts a weak radiosensitising effect on breast and cervical carcinoma cells on the basis ofan optimal Taxol/radiation scheduling[104]

Withania somnifera W. somniferawhen administered for 4 days before paclitaxel treatment and continued for 12 days causedsignificant reversal of neutropenia of paclitaxel in mice. It can be used as an adjuvant during cancerchemotherapy for the prevention of bone marrow depression associated with anticancer drugs[105]. Theactive component, withaferin A isolated from the extract showed significant antitumour and radiosensitisingeffects in experimental tumours in vivo, without any noticeable systemic toxicity[106]. In Ehrlich ascitescarcinoma mice, the extract showed dose dependent inhibition on tumour growth and increased the survivalrate. Combination of radiation therapy with extract increased tumour cure and tumour-free survival[107]. Italso reduces cyclophosphamide induced myelosuppression and leucopoenia can be useful in combinationchemotherapy[108,109]

racemosa, Vitis vinifera, Plumbago zeylenica, Tinosporacordifolia, Zingiber officinale, Coptidis rhizoma, etc. Theseherbs have been shown to improve appetite, food intake,malnutrition, fatigue and sensation of well-being whichcould elicit bodyweight gain. These herbs might stimulatethe flow of digestive juices, thereby improving digestionand increasing the appetite.Aegle marmelos, Holarrhena

antidysenterica, Punica granatum, Cyperus rotundus, Em-blica officinalis, and Plumbago zeylanicacan be used asanti-diarrhoeals when diarrhoea becomes one of the com-plications of cancer cachexia.Terminalia chebulacould beuseful against chronic constipation and digestive disorderswhich are common in cancer patients resulting in loss ofappetite.Eclipta prostrata, Emblica officinalis, Withania


Table 5Pharmacological details of Ayurvedic anticancer herbs[110–114]

Name of the herb Therapeutic dose Safety/duration/toxicdose

Side effects/contraindications Interactions with otherherbs/drugs

Abrus precatorius Leaf decoction:56–112 ml, root powder:0.5–1 g

Likely safe Nausea, stomachcramping, coma,circulatory collapse

None known

Allium sativum 2–5 g per day, solidextract: 0.3–1 g, oil:0.03–0.12 ml t.i.d.

Likely safe Excess can causestomach upset. Mayincrease the risk ofhemorrhagiccomplications

May interact with aspirin

Aloe vera Extract: 10–20 ml,powder: 0.05–0.2 g

Safe for short termtherapy

Long term intake mayaggravate ulcers,haemorrhoids

Possibly interact withcardiac glycosides anddiuretics

Alstonia scholaris Liquid extract: 4–8 ml Insufficient informationavailable

Lethargy, Nasalcongestion, allergy

Interact with St. John’swort, general anaesthetics

Amorphopalluscampanulatus

0.3–0.6 g Likely safe None reported None known

Anacardium occidentale No typical dosage Safe None reported None knownAndrographis paniculata Powder: 1.5–6 g, juice of

leaves and stem: 1–4 mlt.i.d., andrographolide:4–6 mg

Safe Nausea, anorexia,emesis, Urticaria

Interact withanticoagulant andantihypertensivedrugs/herbs

Asparagus racemosa Powder: 20–30 g Safe No adverse effects None knownBacopa monniera 5–10 g (0.4–0.5 g 8×)

per daySafe Rarely cause dermatitis None known

Berberis aristata Powder: 1–3 g May be toxic at higherdosage

May cause lethargy, nosebleeds, nausea, vomiting,diarrhoea

May interfere withVitamin B assimilation

Boswellia serrata 0.4 g/2–3 times a day,gum resin: 2–3 g, oil:1–1.5 ml, bark decoction:56–112 ml

Safe No adverse effectsreported

None known

Calotropis cylindric 0.5–1 g Likely unsafe Vomiting, diarrhoea,bradycadia

May interact withcardioactive herbs andhorsetail

Curcuma longa 1.5–3.0 g Safe, non-toxic Contraindicated ingastric ulcers

No interactions reported

Datura stramonium 0.05–0.1 g Likely unsafe Vomiting, hypertension,loss of consciousness.May lead to coma

May interact withanti-cholinergic drugs

Erythrina suberosa 28–32 g Insufficient informationavailable

Insufficient informationavailable


Euphorbia hirta Powder: 0.12–0.3 g,liquid extract: 0.1–0.3 ml

No information aboutsafety. Tolerable dose: upto 1 g/i.p. in mice

Nausea, vomiting,dermatitis with skincontact

No interactions known tooccur

Ficus religiosa Powdered bark: 1–3 g,liquid extract: 60–120 ml

Likely safe at givendosage

Large amounts can causecatharsis/allergies

None reported

Gynandropis pentaphylla 2 g Insufficient informationavailable



Hygrophila spinosa Seed powder: 2–8 g,liquid extract: 40–50 ml




Ixora crocinea 2–2.5 g Insufficient informationavailable



Juniperus communis 2–10 g per day Limit to maximum of 6weeks Likely safe forshort term

Long term may causekidney damage

Possibly interact withanti-diuretic drugs

Luffa cylindrica 1.3 –1.9 g Likely safe None reported No interactions known tooccur

Melia azedarach Liquid extract: 15–30 ml Insufficient informationavailable



Nerium indicum 0.25–0.4 g Likely unsafe Nausea, vomiting,diarrhoea

None known

Nigella sativa 1–3 g Safe No adverse effectsreported

No interactions known


Table 5 (Continued)

Name of the herb Therapeutic dose Safety/duration/toxicdose

Side effects/contraindications Interactions with otherherbs/drugs

Ocimum sanctum 1–3 g, leaf infusion:4–12 ml

Likely safe May cause constipationat higher dosage for longterm

None known

Paederia foetida 2–4 g, infusion: 12–24 ml,liquid extract: 56–112 ml

Non-toxic up to 2 g/kg inrats and mice



Phyllanthus niruri Powder: 3–6 g Safe None reported None reportedPicrorrhiza kurroa 0.5–1 g Low potential for toxicity Nausea, diarrhoea, skin

rash at high doses,contraindications inpregnancy

None known

Piper longum 0.5–1 g Likely safe May have contraceptiveactivity, avoid use duringpregnancy and lactation

Piperine may interactwith enzymatic drugbiotransformation

Plumbago zeylanica 1–2 g Plumbagin LD50

10 mg/kg in mice, wholeplant: 0.5 g/kg/i.p.

None reported None known

Raphanus sativus 15–23 g, liquid extract:50–100 ml

Likely safe Large amounts maycause irritation of GImucus membrane


Rubia cordifolia Powder: 1–3 g, liquidextract: 56–112 ml

Generally recognized assafe

No adverse effectsreported

None known

Semecarpus anacardium Oil: 1–2 drops, fruit:0.5–1.5 g

Likely unsafe Anacardic acid may beallergenic

No sufficient informationavailable

Taxus buccata Dosage depends onseverity of the disease

Likely unsafe Vomiting, abdominalpain, dyspnea


Tinospora cordifolia Powder: 1–3 g, liquidextract: 56–112 ml

Safe Nausea Excessive dose mightinhibit Vitamin Bassimilation

Vinca rosea Dosage depends onseverity of the disease

Likely unsafe GI upset, hepatotoxicity,nausea, vomiting, mayalso cause hypoglycemia


Vitis vinifera 0.15–0.3 g Safe None reported None knownWithania somnifera 2–6 g Likely unsafe Nausea, dermatitis,

abdominal pain, diarrhoeaMay potentiate the actionof barbiturates andbenzodiazepines

somnifera, Piper longumcan be directed to correct nau-sea and vomiting[60]. Among the above-mentioned herbs,Withania somnifera[61] andTinospora cordifolia[42] arealso proven to be powerful immunostimulants, which couldincrease body resistance power during cancer associatedimmunosuppression.

Ayurvedic anticancer therapy includes recommendationsfor lifestyle and use of specific foods and herbs which arevery helpful not only in preventing the progression of thedisease but also makes the patients feel better and com-fortable overcoming the symptoms.Allium sativum(garlic)could be helpful to manage pain and ache.Bacopa monnierastrengthens mental faculties and helps to manage insomniaor sleeplessness due to stress[62]. An herbal combinationof Withania sominifera, Asparagus racemosa, Hydrocotyleasiatica, Nardostachys jatamamsi, Elettaria cardamomum,Tribulus terrestris, Zingiber officinalis and Eclipta albacould also be useful in the treatment of anxiety, tensionand insomnia.Ocimum sanctumis beneficial against stressand depression during cancer.Curcuma longa, Zingiber of-ficinale, Glycyrrhiza glabra, Terminalia chebula, Ocimumsanctumand Adhatoda vasicaare used to control cough

and shortness of breathe especially for lung cancer patients[60]. Thus, ayurvedic therapeutic regimen rejuvenates thebody tissues, tones up the systems and act as a tonic tothe body against cancer cachexia. This kind of orientationtoward total healing and health promotion makes ayurvedictreatment approach to cancer therapy promising.

4. Cancer therapy in Ayurveda—learning from thepast, examining the present and advancing to the future

Because large population use ayurvedic medicine world-wide, there is an urgent need for additional, carefullyconducted, high-quality intensive research to evaluate itsefficacy and to develop this discipline to meet ever-newchallenges of modern medicine in the field of oncology.The most stringent evaluation should take place with goldstandards for clinical research—the randomised controlledclinical trial (RCT). Priority for research funding shouldbe given to clinical investigations in Ayurveda involvingwell-designed studies with encouraging results especiallyfor diseases like cancer to which conventional medicine


has been shown to be less effective. Attention should begiven not only to the evaluation of safety and examinationof effectiveness in treatment strategy, but also to the con-sideration of community practice settings, patient expecta-tions, compliance and cost effectiveness. Standardizationand quality production of herbal products may allow us todevelop low cost therapies with reduced risk over pharma-ceuticals. In any case, studies on anticancer ayurvedic drugswill be popular from the economy point of view becausecancer is becoming the major cause of death.

5. Conclusion and future directions

The clinical efficacy and extent of toxicity of numerousanticancer agents are unknown and uncertain. For example,research on majority of ayurvedic drugs is in the pre-clinicalphase or is not being actively pursued. Future research onthis topic would help to identify safe and effective anti-cancer drugs and will further the exploration of their mech-anism of action. Ayurvedic practitioners and researchers inmedical sciences can help to improve this medicine by in-creasing their involvement and contribution. Case study isthe research design, which can form basis for future re-search directions and can provide valuable contributions tothe medical field with minimal cost budgets. Case studieshave also been suggested by the NCCAM (National Cen-ter for Complementary and Alternative Medicine, Bethesda,USA) as a means to determine whether a complementaryanticancer therapy demonstrates potential efficacy againstparticular cancer and whether clinical development of thetherapy should continue[63,64]. It is no longer an optionto ignore ayurvedic drugs or treat them as something un-conventional from regular medical practices. The challengeput before this medicine is to move forward carefully, usingboth reasoning and wisdom.

References

[1] Hartwell JL. Plants used against cancer. A survey. Lloydia1969;32:247–96.









[10] Pandey G. Anticancer herbal drugs of India with special referenceto Ayurveda. New Delhi: Sri Satguru Publications; 2002:18–121.

[11] Sharma PV. Charaka samhita. Varanasi: Choukhamba Orientalia;1981.

[12] Bhishagratha KL. Sushruta samhita. Varanasi: Choukhamba Orien-talia; 1991.

[13] Prasad GC. Studies on cancer in Ayurveda and its management.JRAS 1987;3:147–67.

[14] Singh RM. An assessment of ayurvedic concept of cancer and a newparadigm of anticancer treatment in Ayurveda. J Altern ComplementMed 2002;8:609–14.

[15] Sankaran PS. Swellings. In: Prasad GC, Udupa KN, editors.Susruta’s contribution to surgery. Varanasi: Indological Book House;1976. p. 99–111.

[16] Dash B, Kashyap L. Diagnosis and treatment of Galaganda, Gan-damala, Apaci, granthi and arbuda. In: Dash B, Kashyap L, edi-tors. Diagnosis and treatment of diseases in ayurveda. New Delhi:Concept Publishing Company; 1987. p. 437–66.

[17] Sastry JLN. Introduction to oncology, cancer in Ayurveda. Varanasi:Chaukhambha orientalia; 2001. p. 1–24.

[18] Thatte U, Dhahanukar S. Ayurveda, the natural alternative. SciToday 1991;2001:12–8.

[19] Ram A. Astanga-hrdaya of vagbhata. vol. III. Uttara-sthana. Delhi:Uppal Publishing House; 1999.

[20] Kinjavadekara RS. Astanga sangraha. New Delhi: Uppal PublishingHouse; 1998.

[21] Sharma PV. Chakradatta: a treatise on principles and practices ofAyurvedic medicine. New Delhi: Vedams Books International; 1998.

[22] Murthy KRS. Sarangadhara samhita. Varanasi: Chaukambha Orien-talia; 1987.

[23] Murthy KRS. Bhavaprakasa of bhavamisra. vol. II. Madhya andUttara Khanda. Varanasi: Krishnadas Academy; 2001.

[24] Sonata S. The efficacy of Ayurveda drugs on Cancer (Arbuda).Workshop on cancer souvenir. Chennai: Central Research Institutefor Siddha; 1986.

[25] Treadway S. An Ayurvedic herbal approach to a healthy liver. ClinNutr Insights 1998;6:1–3.

[26] Trivedi N, Rawal UM. Effect of aqueous extract ofAndrographispaniculataon liver tumour. Indian J Pharmacol 1998;30:318–22.

[27] Trivedi NP, Rawal UM. Hepatoprotective and antioxidant propertyof Andrographis paniculatain BHC induced liver damage in mice.Indian J Exp Biol 2001;39:41–6.

[28] Singh RP, Bannerjee S, Rao AR. Modulatory influence ofAn-drographis paniculataon mouse hepatic and extrahepatic carcino-gen metabolising enzymes and antioxidant status. Phytother Res2001;15:382–90.

[29] Kapil A. Antihepatoxic effects of major diterpenoid constituents ofAndrographis paniculata. Biochem Pharmacol 1993;46:182–5.

[30] Chih H, Chiu HF, Tang KS, Chang FR, Wu YC. Bullatacin, a potentantitumour annonaceous acetogenin, inhibits proliferation of humanhepatocarcinoma cell line 2.2.15 by apoptosis induction. Life Sci2001;69:1321–31.

[31] Chang FR, Wu YC. Novel cytotoxic annonaceous acetogenins fromAnnona muricata. J Nat Prod. 2001;64:925–31.

[32] Rajeshkumar NV, Kuttan R.Phyllanthus amarusextract adminis-tration increases the life span of rats with hepatocellular carcinoma.J Ethnopharmacol 2000;73:215–9.

[33] Lee CD, Ott M, Thyagarajan SP, Shafritz DA, Burk RD, GuptaS. Phyllanthus amarusdown-regulates hepatitis B virus mRNAtranscription and replication. Eur J Clin Invest 1996;26:1069–76.

[34] Koul IB, Kapil A. Evaluation of the liver protective potential ofpiperine. Planta Med 1993;59:413–7.

[35] Cavalli F, Tschopp L, Gerber A, Sonntag RW, Ryssel HJ, BrunnerKW. Therapiersultate mit VP 16.213 allein oder kombiniert mit5-fluorouracil beim leberzell karzinom (hepatoma), Schweiz. MedWochenschr 1977;107:1960–6.


[36] Pallavacini EB, Porta C, Moroni M, Moroni M, Bertulezzi G, CivelliL, et al. Epirubicin and etoposide combination chemotherapy totreat hepatocellular carcinoma patients: a phase II study. Eur JCancer 1997;33:1784–8.

[37] Nerenstone SR, Ihde DC, Friedman MA. Clinical trials in primaryhepatocellular carcinoma: current status and future directions. Can-cer Treat Rev 1988;15:1–31.

[38] Park JG, Lee SH, Hong IG, Kim HS, Lim KH, Choe KJ, et al.MDR1 gene expression its effect on drug resistance to doxorubicinin human hepatocellular carcinoma cell lines. J Natl Cancer Inst1994;86:700–5.

[39] Aita P, Robieux I, Sorio R, Tumolo S, Corona G, Cannizzaro R, et al.Pharmacokinetics of oral etoposide in patients with hepatocellularcarcinoma. Cancer Chemother Pharmacol 1999;43:287–94.

[40] Sohini YR, Bhatt RM. Activity of a crude extract formulation inexperimental hepatic amoebiasis and in immunomodulation studies.J Ethnopharmacol 1996;54:119–24.

[41] Kapil A, Sharma S. Immunopotentiating compounds fromTinosporacordifolia. J Ethnopharmacol. 1997;58:89–95.

[42] Matthew S, Kuttan G. Immunomodulatory and antitumour activitiesof Tinospora cordifolia. Fitoterapia 1999;70:35–43.

[43] Sharma PV, Chaturvedi C, Bandhopadhyaya NG. A study on dosageand toxicity of Bhallataka (Semecarpus anacardiumLinn.). J ResIndian Med 1966;I:130.

[44] Premalatha B.Semecarpus anacardiumLinn. nuts—a boon in al-ternative medicine. Indian J Exp Biol 2000;38:1177–82.

[45] Cassady JM, Chang CJ, McLaughlin JL. Recent advances in theisolation of structural elucidation of antineoplastic agents of higherplants. In: Beal JL, Reinhard E, editors. Natural products as medic-inal agents. Verlag: Hippokrates; 1981. p. 93–105.

[46] Chitinis MP, Bhatia KG, Phatak MK, Kesava Rao KV. Antitumouractivity of the extract ofSemecarpus anacardiumL. nuts in exper-imental tumour models. Indian J Exp Biol 1980;18:6–8.

[47] Premalatha B, Sachdanandam P. Immunomodulatory activity ofSe-mecarpus anacardiumLinn. Nut milk extract in Aflatoxin B1 in-duced hepatocellular carcinoma in rats. Pharm Pharmacol Commun1998;4:507–10.

[48] Premalatha B, Muthulakshmi V, Sachdanandam P. Anticancer po-tency of the milk extract ofSemecarpus anacardiumLinn. nutsagainst aflatoxin B1 mediated hepatocellular carcinoma bearing Wis-tar rats with reference to tumour marker enzymes. Phytother Res1999;13:183–7.

[49] Premalatha B, Sachdanandam P. Effect ofSemecarpus anacardiumnut milk extract on rat serum alpha-fetoprotein level in aflatoxin B1

mediated hepatocellular carcinoma. Fitoterapia 1999;70:279–83.[50] Premalatha B, Sachdanandam P. Stabilization of lyzosomal mem-

brane and cell membrane glycoprotein profile bySemecarpus anac-ardium Linn. Nut milk extract in experimental hepatocellular car-cinoma. Phytother Res 2000;14:352–5.

[51] Premalatha B, Sachdanandam P. Regulation of mineral status bySemecarpus anacardiumLinn. nut milk extract in aflatoxin B1induced hepatocellular carcinoma. J Clin Biochem Nutr 1998;25:63–70.

[52] Premalatha B, Sujatha V, Sachdanandam P. Modulating effect ofSemecarpus anacardiumLinn. nut extract on glucose metabolis-ing enzymes in aflatoxin B1 induced experimental hepatocellularcarcinoma. Pharmacol Res 1997;36:187–92.

[53] Premalatha B, Muthulakshmi V, Vijayalakshmi T, SachdanandamP. Semecarpus anacardiumnut extract induced changes in enzymicantioxidants studied in aflatoxin B1 caused hepatocellular carcinomabearing Wistar rats. Int J Pharmacog 1997;35:1–6.

[54] Premalatha B, Sachdanandam P.Semecarpus anacardiumL nut ex-tract administration induces the in vivo antioxidant defense systemin aflatoxin B1 mediated hepatocellular carcinoma. J Ethnopharma-col 1999;66:131–9.

[55] Premalatha B, Sachdanandam P. Potency ofSemecarpus anacardiumLinn. nut milk extract against aflatoxin B1 induced hepatocarcino-

genesis: reflection on microsomal biotransformation enzymes. Phar-macol Res 2000;42:161–6.

[56] Premalatha B, Sachdanandam P. Modulating role ofSemecarpusanacardiumL. nut milk extract on aflatoxin B1 biotransformation.Pharmacol Res 2000;41:19–24.

[57] Premalatha B, Sachdanandam P. Effect ofSemecarpus anacardiumnut extract against aflatoxin B1 induced hepatocellular carcinoma.Fitoterapia 1999;70:484–92.

[58] Vad BG. Study of complete regression in four cases of cancer. TheIndian Practitioner 1973;26:253–63.

[59] Smit HF, Woerdenbag HJ, Singh RH, Meulenbeld GJ, LabadieRP, Zwaving JH. Ayurvedic herbal drugs with possible cytostaticactivity. J Ethnopharmacol 1995;47:75–84.

[60] Nayak B. Pharmacological index-Ayurmedline. Bangalore:Seetharam Prasad; 2002. p. 447–682.

[61] Agarwal R, Diwanay S, Patki P, Patwardhan B. Studies on im-munomodulatory activity ofWithania somnifera(Ashwagandha)extracts in experimental immune inflammation. J Ethnopharmacol1999;67:27–35.

[62] Bakhru HK. Conquering cancer naturally. Delhi: Chaukhamba San-skrit Pratishthan; 2000. p. 1–6.

[63] OAM. Office of alternative medicine workshop on the collection ofclinical research data relevant to alternative medicine and cancer.Bethesda: Office of Alternative Medicine; 1994.

[64] Boik J. Conducting research on natural agents. In: Boik J, editor.Cancer and natural medicine. Minnesota: Oregon Medical Press;1996: p. 176–87.

[65] Singhal GD, Singh LM. The management of glandular swellings,cervical lymphadenopathy, tumours and goiters. In: Singhal GD,Singh LM, editors. Operative considerations in ancient Indiansurgery based onSusruta Samhita, Cikitsa sthana. Varanasi: SinghalPublications; 1982. p. 339–56.

[66] Jang M, Cai L, Udeani GO, Beecher CWW, Fong HHS, FarnsworthNR, et al. Cancer chemopreventive activity of Resveratrol, a naturalproduct derived from Grapes. Science 1997;275:218–20.

[67] Subbareddy VV, Sirsi M. Effect ofAbrus precatoriusLinn. onexperimental tumours. Cancer Res 1969;29:1447–51.

[68] Dhar ML, Dhar MM, Dhawan BN, Mehrotra BN, Ray C. Screeningof Indian plants for biological activity, Part-I. Indian J Exp Biol1968;6:232–47.

[69] Hu X, Cao BN, Hu G, He J, Yang DQ, Wan YS. Attenuation ofcell migration and induction of cell death by aged garlic extract inrat sarcoma cells. Int J Mol Med 2002;9:641–3.

[70] Corsi MM, Bertelli AA, Gaja G. The therapeutic potential ofAloevera in tumour-bearing rats. Int J Tissue React 1998;20:115–8.

[71] Pecere T, Gazzola MV, Mucignat C, Parolin C, Vecchia FD, Cav-aggioni A, et al. Aloe-emodin is a new type of anticancer agentwith selective activity against neuroectodermal tumours. Cancer Res2000;60:2800–4.

[72] Jagetia GC, Baliga MS, Venkatesh P. Effect ofSapthaparna(Al-stonia scholarisLinn) in modulating the benzo(a)pyrene-inducedforestomach carcinogenesis in mice. Toxicol Lett 2003;144:183–93.

[73] Prasad GC, Deshpande PJ. Effect of Rohitaka (Amura rohitaka) onleukaemia. J Res Indian Med 1968;3:36.

[74] Rabi T, Gupta RC. Antitumour and cytotoxic investigations ofAmura rohitaka. Int J Pharmacogn 1995;33:359–64.

[75] Bhakuni DS, Dhar ML, Dhar MM, Dhawan BN, Mehrotra BN.Screening of Indian plants of biological activity, Part-II. Indian JExp Biol 1969;7:250–62.

[76] Anis KV, Rajeshkumar NV, Kuttan R. Inhibition of chemical car-cinogenesis by berberine in rats and mice. J Pharm Pharmacol2001;53:763–8.

[77] Hostanska K, Daum G, Saller R. Cytostatic and apoptosis-inducingactivity of boswellic acids toward malignant cell lines in vitro.Anticancer Res 2002;22:2853–62.

[78] Sriganth NPI, Premalatha B. Dietary curcumin with cis-platin administration modulates tumour marker enzymes indices


in experimental fibrosarcoma. Pharmacol Res 1999;39:175–9.

[79] Aggarwal BB, Kumar A, Bharti AC. Anticancer potential of cur-cumin: preclinical and clinical studies. Anticancer Res 2003;23:363–98.

[80] Pal S, Chakraborti SK, Banerjee A, Mukerji B. Search for anticancerdrugs from Indian medicinal plants. Indian J Med Res 1968;56:445–55.

[81] Maiti B. Antineoplastic effects of the root extract ofHygrophilaspinosa. In: Proceedings of the International Conference on CurrentProgress in Medicinal and Aromatic Plant Research. Calcutta, India;1994. p. 135–40.

[82] Mazumdar UK, Gupta M, Maiti S, Mukherjee D. Antitumour ac-tivity of Hygrophila spinosaon Ehrlich ascites carcinoma andsarcoma-180 induced mice. Indian J Exp Biol 1997;35:473–7.

[83] Dhawan BN, Dubey MP, Mehrotra BN, Rastogi RP, Tandon JS.Screening of Indian plants for biological activity, Part-IX. Indian JExp Biol 1980;18:594–606.

[84] Bhakuni DS, Dhar ML, Dhar MM, Dhawan BN, Gupta B, SrimalRC. Screening of Indian plants of biological activity, Part-III. IndianJ Exp Biol 1971;9:91–102.

[85] Bharali R, Tabassum J, Azad MR. Chemomodulatory effect ofMoringa oleifera Lam., on hepatic carcinogen metabolising en-zymes, antioxidant parameters and skin papillomagenesis in mice.Asian Pac J Cancer Prev 2003;4:131–9.

[86] Salim EI, Fukushima S. Chemopreventive potential of volatile oilfrom black cumin (Nigella sativaL.) seeds against rat colon car-cinogenesis) seeds against rat colon carcinogenesis. Nutr Cancer2003;45:195–202.

[87] Dubey NK. Cytotoxicity of the essential oil ofCymbogon cit-rus and Ocimum gratissimum. Indian J Pharm Sci. 1997;59:263–9.

[88] Parimala R, Sachdanandam P. Effect of Plumbagin on some glucosemetabolising enzymes studied in rats in experimental hepatoma.Mol Cell Biochem 1993;125:59–63.

[89] Itokawa H, Takeya K, Mori N, Hamanaka T, Sonobe T, MiharaK. Isolation and antitumour activity of cyclic hexapeptides isolatedfrom Rubia radix. Chem Pharm Bull 1984;32:284–90.

[90] Mellado W, Magri NF, Kingston DG, Garcia-Arenas R,Orr GA, Horwitz SB. Preparation of biological activity oftaxol acetates. Biochem Biophys Res Commun 1984;124:329–36.

[91] Rastogi RP, Merhotra BN, editors. Compendium on Indian medic-inal plants. New Delhi: CSIR publications; 1993.

[92] Shirin H, Pinto JT, Kawabata Y, Soh JW, Delohery T, Moss SF,et al. Antiproliferative effects of S-allylmercaptocysteine on coloncancer cells when tested alone or in combination with sulindacsulfide. Cancer Res 2001;61:725–31.

[93] Olsen DL, Bradley C, Johnson M, Macias JL, Love V, Markoe A.The effect ofAloe veragel/mild soap versus mild soap alone inpreventing skin reactions in patients undergoing radiation therapy.Oncol Nurs Forum 2001;28:543–7.

[94] Lissoni P, Giani L, Zerbini S, Trabattoni P, Rovelli F. Biother-apy with the pineal immunomodulating hormone melatonin versusmelatonin plus aloe vera in untreatable advanced solid neoplasms.Nat Immun 1998;16:27–33.

[95] Jagetia GC, Baliga MS. Treatment withAlstonia scholarisenhancesradiosensitivity in vitro and in vivo. Cancer Biother Radiopharm2003;18:917–29.

[96] Jagetia GC, Baliga MS. Modulation of antineoplastic activity ofcyclophosphamide byAlstonia scholaris in the Ehrlich ascitescarcinoma-bearing mice. J Exp Ther Oncol 2003;3:272–82.

[97] Baatout S, Derradji H, Jacquet P, Ooms D, Michaux A, Mergeay M.Effect of curcuma on radiation-induced apoptosis in human cancercells. Int J Oncol 2004;24:321–9.

[98] Ohnuma T, Sridhar KS, Ratner LH, Holland JF. Phase I study ofindicine N-oxide in patients with advanced cancer. Cancer TreatRep 1982;66:1509–15.

[99] Rao AV, Devi PU, Kamath R. In vivo radioprotective effect ofMoringa oleifera leaves. Indian J Exp Biol 39:858–63.

[100] Badary OA. Thymoquinone attenuates ifosfamide-induced Fanconisyndrome in rats and enhances its antitumour activity in mice. JEthnopharmacol 1999;67:135–42.

[101] Vrinda B, Uma Devi P. Radiation protection of human lympho-cyte chromosomes in vitro by orientin and vicenin. Mutat Res2001;498:39–46.

[102] Zaniboni A, Ardizzoni A, De Marinis F, Portalone L, Boni C,Meriggi F, et al. Phase II study of Taxol combined with ifosfamideand carboplatin in the treatment of stage IIIb-IV non-small-celllung cancer. Am J Clin Oncol 2003;26:84–8.

[103] Lang I. Possibilities and results with Herceptin-Taxol combinationin the treatment of breast cancer. Magy Onkol 2002;46:195–6.

[104] Rave-Frank M, Meden H, Jaschke A, Tanzer A, Boghun O, FietkauR. The effect of paclitaxel on the radiosensitivity of gynecologicaltumour cells. Strahlenther Onkol 1997;173:281–6.

[105] Gupta YK, Sharma SS, Rai K, Katiyar CK. Reversal of paclitaxelinduced neutropenia byWithania somniferain mice. Indian J PhysiolPharmacol 2001;45:253–7.

[106] Devi PU.Withania somniferaDunal (Ashwagandha): potential plantsource of a promising drug for cancer chemotherapy and radiosen-sitisation. Indian J Exp Biol 1996;34:927–32.

[107] Sharada AC, Solomon FE, Devi PU, Udupa N, Srinivasan KK.Antitumour and radiosensitising effects of withaferin A on mouseEhrlich ascites carcinoma in vivo. Acta Oncol 1996;35:95–100.

[108] Praveenkumar V, Kuttan R, Kuttan G. Chemoprotective ac-tion of Rasayanas against cyclophosphamide toxicity. Tumouri1994;80:306–68.

[109] Davis L, Kuttan G. Suppressive effect of cyclophosphamide-inducedtoxicity by Withania somniferaextract in mice. J Ethnopharmacol1998;62:209–14.

[110] Williamson EM. Major herbs of Ayurveda. London: Churchill Liv-ingstone; 2002.

[111] Jellin JM, Gregory P, Batz F, Hitchens K. Pharmacist’sletter/prescriber’s letter natural medicines comprehensive database.3rd ed. Stockton, California: Therapeutic Research Facility; 2000.

[112] Ross IA. Medicinal parts of the world. New Jersey: Humana Press;1999.

[113] Forget L, Goldrosen J, Hart JA, Hyun T, Meachen D, Tyler T, et al.Herbal companion. Bethesda: American Society of Health SystemPharmacists; 2000.

[114] Kuhn MA. Winston D. Herbal therapy and supplements. Philadel-phia: Lippincott; 2000.

Documents

Cancer - An Ayurvedic Perspective